Low-gic.

If I ignore the buzzing, the arrows will magically change direction. Look at me, laying here in bed defiantly! Ha HA!

Can I wish it away? Like, really, really wish? Or just pretend I didn't hear it? This will totally work this time.

Absolutely, I should eat peanut butter straight out of the jar. And these cookies. And a glass of almond milk. And more cookies. And bread with butter. Is butter a carb?

I can totally finish vacuuming this room, first. Now I'll go... oooo, that spill on the counter. I forgot about that. Gotta wipe that up. Now, where was... the window! It still has smears on it! First things first.

That conversation I half-remember having with my husband earlier today was clearly about how he shouldn't trust my judgement when I'm low, which means that he will obviously wake out of a deep sleep just because my CGM beeped once and will know, without speaking, that he needs to procure some quick-acting carbs for me RIGHT NOW. Wait.. still snoring. NOW. I'll just lay here a bit more. He'll wake up. Didn't we just talk about this? I'm pretty sure it was about me being low. So he'll wake up..... now. 

It's not logic. It's low-gic.

The Answer.

All of a sudden, I couldn't focus my eyes on anything.

I knew my 8 month-old daughter had her eyes fixed on me; my peripheral vision worked enough for me to know that she was jubilantly swinging her legs back and forth in the seat of the grocery cart. I could tell that she was grinning and waiting for me to return her smile, as she often does. Instead I reached behind her to grab my purse.

My hand instinctively went first to my Dexcom receiver. I clicked the button to wake it up, and it told me I was at 113 mg/dL with a straight arrow, meaning that it thought my blood sugar was in range and steady. "I don't think that's right", I mumbled out loud - there's no other reason my vision would have suddenly changed. Reaching to the right-most interior pocket, I searched for that plastic tube's familiar shape; the one that holds my glucose tabs.

I picked it up and shook it. Empty.

"Ugh, are you seeeeeerious...", I muttered. I turned the cart around and headed for the checkout, still unable to really focus but knowing that all of the fast-acting sugar was up by the registers, so that's where we needed to go. Should I try to test?, I thought to myself. I decided against it for two reasons: I knew that trying to balance a testing kit on the handle of the grocery cart was a no-go because tiny hands would try to "help", and I also knew that it was safer to just treat the possible low blood sugar when in doubt, and test later to confirm. I caught Rabbit's gaze, smiling meekly at her. I would keep us safe. I would keep her safe. "We're okay", I said out loud in a sing-songy voice, mostly to her but also to try to convince myself because I wasn't so sure we were.

We got to the checkout and my eyes found the soda cooler. I don't want soda, part of my mind said. Don't they have juice? I don't see any. When I tried to look at the candy display to my right, it shifted and blurred. I could not come to a decision. Chocolate isn't a great low treatment because it doesn't work as quickly. Do they have Starbursts? Wait, that's not good either; lots of chewing. And on and on, until the rational part of my brain ducked its head in, cutting through the low-induced indecision for juuuuust a second to say, Literally ANY OF THESE THINGS can save your life right now, just pick one and eat it.

With Snickers bar in hand, I swiped my debit card. I didn't even know how much we had spent, but we had two bags of groceries suddenly ready to go in the main compartment of our cart. Maybe once I start walking, my eyes will be able to focus. (Sidenote: I have no idea why I thought this.)

I pushed the cart of precious cargo out to the parking lot, still not touching the Snickers. Too many things to juggle at once; I'll eat it once we get to the car. The sunlight hit our faces and the Rabbit squinted her eyes. "We're aaaaallmost there, punkin'." I felt the symptoms of the low finally kick in - I felt weak and helpless but determined that I would not pass out on the way to the car.

And I didn't - I even got the groceries into the trunk and my daughter into her carseat. (Not gracefully, but I did it.) Only as I finished inhaling the Snickers bar did I realize we'd bought bananas, so I ate one of those too. I turned up the radio (silent cars seem to upset the wee one) and we sat for a while in the parked car, my daughter batting at her toy monkey hanging from the carseat handle and me finally testing my blood sugar a few minutes later.

53 mg/dL.

That's the thing about living with diabetes - I'm fine, until I'm not. Once lucid again, I scolded myself for potentially putting us both in danger: Couldn't I have treated that low before we ever left the safety of the building, instead of confining myself to the car where no one might notice if I passed out? Shouldn't I have checked my glucose tab supply before we ever set foot in the store, knowing that grocery shopping makes me often run low? What if I did pass out? Would my daughter be okay? Would the paramedics find my medical ID bracelet; the one whose colorful beads make it look a lot like a normal, recreational one? Should I have said something to someone? Diabetes gives me so many reasons to question myself.


You can be as vigilant as possible, use the latest devices, dutifully take every medication on time, and eat all of the "right" things, and incidents like this can still happen. The answer to "Am I okay?" always has this asterisk on it, as the answer is never completely yes or no.

The knee-jerk response when I say that "I'm fine" belies the intricate nature of what's going on both in my body and in my mind, and I hate that sometimes I have to admit that the answer to the question "Are you okay?"  isn't so cut-and-dry:

Probably? I guess we'll know in a few minutes.

Watching Over Gotham.

"What am I doing?", my endocrinologist said to herself, out loud. "This goes against all of my training! But, it's what your numbers are telling me..."

Sounds right.

It seems like my insulin needs have never quite matched up with what's considered "standard", whether it's the ratio of daily bolus to basal insulin, the increase in basal rates while I'm sleeping (my body won't even look at insulin while I'm dreaming; it's that resistant), or the number of basal rates I'm running throughout the day (they once totaled 12 rates in one day, and it worked really well at the time).

It doesn't surprise me that my endo (whom I adore - I've only had two appointments with her and I'd already like to send her a basket of puppies and chocolate, though not in the same basket because then I'm sending her a basket of dead puppies, and what the hell kind of tangent is this) is needing to do things a bit differently to keep me in range - and you know what? So far, it's working pretty well.

But while basal rate changes help, they don't do all of the work for me. I still see myself trending down several times a day, but it sort of works out for now since pregnancy has brought me a bottomless pit for a stomach. "Oh! Cool! I can eat again." But things change sporadically, randomly, and often - much like Batman watching over his beloved Gotham, I too must remain vigilantly attentive to what's going on around (and in) me.

I'm back in super-obsessive mode, which means I'm clicking the Dexcom button every few minutes (even though I know it only updates every five) and doing a finger stick about every hour and a half - but sometimes I'll get crazy and wait TWO HOURS YOU GUYS! I haven't gone through this many lancets in... ever? My fingers are losing their patience with me swiftly.

What would be reeeeeally wonderful right about now is this:

That's the Artificial Pancreas system that Tom Brobson, JDRF National Director of Research Investment Opportunities (and star of this YouTube video detailing his experience using this thing in a real-world setting) brought along with him to a JDRF breakfast here locally on Wednesday, that I felt very lucky to be able to attend. It's not perfect - no technology is - but having a system that would look out for me and minimize the highs and lows? I'd take it in a heartbeat.

Until then, I will do my throw my Bat-darts at this ever-moving target called diabetes, in the hopes that I can hit something more often than not.

Skydiving, Revisited.

What it looks like on my CGM:

What it looks like in my mind:

Waiting For The Parachute.

 "So what do your lows feel like?"

It's a question I've been asked many times in the past 26 years. I've been asked this by nurses, doctors, family, friends, and strangers. While I don't think that my actual symptoms have changed that much, the words and images I use to describe them over time have.

As a child I associated hypoglycemia with feelings like "weak, shaky and tired". It was a very distinct feeling; one where I wanted to eat and eat and eat and then sleep until I felt better. I knew that feeling, but putting it in words was difficult. I used the words I had in my verbal arsenal. (A sentence which, as a child, would have been phrased "I used the words I knew." I love being a grown-up with a thesaurus.)

Fast forward to adulthood: descriptions and metaphors aplenty.

They come in stages, those lows. I might feel a little loopy, hyper, or energetic - which then transitions to feeling a bit like I'm swimming through the air around me. My body vibrates. As I continue to drop (and this ended up being my answer to the above question, the last time I was asked it), it begins to feel similar to being drunk, minus the fun part. In my mind, I know exactly what's going on and what I need to do, but I often can't get my body to follow through with those actions, or my mouth to form the words my mind intends. I'm lucky to get out a short, staccato sentence: "I need juice". My brain sounds the alarm, screaming "YOU NEED SUGAR RIGHT NOW!!!"; it pleads with me to go eat the kitchen, if only my motor skills would show up for duty.

I know what I need to do and say, but my physical self can't translate it.

And when my blood sugar continues to drop after I've already eaten what I need to? I imagine it's much like the freefall in skydiving, before you engage your parachute. It's a swift descent to a very hard landing, and you're doing everything you can to not reach full-scale panic mode. Adrenaline surges. My rational mind knows the chute will engage, but my primative self is scared out of its mind. Even my Dexcom CGM graph resembles that freefall, sometimes sending me deeper into panic. The tumbling seems to pick up speed with every passing second. I repeat to myself, "You're fine. You're fine. You're going to be fine."

And I know I will be fine - once that parachute catches some air.

Grocery Store Lows.

Spirit Animal.

For Martin:

And in case your low blood sugar spirit animal is the same as Martin's, I made you a shirt.

Procrastinating The Lows.

I push the grocery cart down the aisle that hosts the boxed pasta and jars of spaghetti sauce. I can hear my stomach starting to grumble - I had stayed a couple of hours late at work, and on a normal day, I would have already eaten dinner by then. Knowing our fridge was near empty, I stop at the store on my way home. I have half a cart full of food, and I'm ready to leave.

Walking suddenly feels a lot like swimming. Ugh. I just want to get out of here and eat dinner.

Suddenly, I remember that I didn't grab milk. U-turn. Back to the back of the store. Milk in tow. Back to the front.

I really don't want to be low right now. Dinner is sitting right in front of me; I don't want to eat glucose tabs right now too. I can make it.

And salad! I didn't grab lettuce! Spin move; to the produce.

Why does everyone have to be in my way right now? Seriously lady; move your cart over.

Okay; done. Check out.

Why did I get so many things? Got to make sure to put all of the cold things together so they get bagged together.

The girl forgets the reusable bag discount. I just want this to be done.

"Bread? Check. Apples? Check.
Low blood sugar? Check."

My Dexcom LOW!!! alarm goes off.

Hurry hurry hurry hurry... just want to get out of here... 

...oh, crap. 

I had forgotten that this is the store where they bring your groceries to your car for you. Normally, that's helpful. When you're below 55 mg/dL and can't remember exactly where your car is, it's embarrassing.

As soon as the doors swish open and I can see pavement, I start frantically hitting my car remote's lock button, hoping to see the lights flash. The teenage boy watches me, expecting me to lead to where the car is.

I bluff and head down the middle.

BEEP BEEP!

Was that the car or my CGM?

We find the car; I clumsily throw open the back hatch and try to help load things in, so that this goes faster. I say "thank you". I fall into the driver's seat and can finally stop putting off the dusty, chalky glucose tabs in my future.

I don't know why I do this.

I convince myself that I don't need to treat that low right then. I tell myself to wait a few minutes... but for what? I know I'm just going to feel worse, and I know that my blood sugar isn't going to go back up on its own. Rationally, I know these things.

In that moment, however, rational thinking can give way to the decision that procrastinating is a good choice.

I can't explain it.

Please Don't Notice.

Low blood sugars in the workplace are one of my least favorite things.

I had one yesterday - but not a run-of-the-mill, shaky sweaty kind of thing. Nope, this one walked right up and punched me in the face with one of those huge Incredible Hulk fists.

image credit

See, that's the worst part for me - that WHAM! feeling of helplessness, where I'm trapped at my desk and I'm just praying that no one who comes within a five foot radius of me decides to strike up a conversation, because every bit of my energy is focused on trying to appear normal. My mind is this scared, panicking child trapped in an adult body and that child is pleading with all its might that no one notices what's happening.

If only Jodie Foster would come rescue me.

(I might also hope that no one notices that I've had three snacks that morning already - none of which seem to be doing a darn thing, I'd like to point out.)

Rationally, I know that I just need to treat the low and sit tight for a bit. Rationally, I realize that people are generally kind and understanding, and that if I really needed to, I could go hang out in the break room and not be bothered.

But "rational" isn't the state I'm in when my blood sugar is in the same range as my age.

When I feel that way, I know I can't do my best work. (Actually, sometimes I can't even form thoughts or words very accurately - so work is pretty down low on the ol' totem pole.) I know I shouldn't try to do anything right then because my mind isn't operating at full speed, nor are my motor skills cooperating. And yet, I can't help but feel guilty if I do what I need to do - which would be sitting there and recovering for a few minutes. Because "sitting there and recovering" looks an awful lot like "slacking off and not working", and I'm not all about that.

Lows at work feel worse than any others, because not only am I dealing with the symptoms of that lack of glucose in my bloodstream, but I'm also trying to (over) compensate for myself. 

The hardest part is balancing the appearance of a "normal" outside with the temporary raging chaos inside.

Note To Self.

Always, always, always consult with Jim before deciding to brush your chompers.

You shouldn't be this familiar with the late night taste of orange juice laced with toothpaste.

Puppy Lows.

I love this pup; I really do.

This pup, who on a brand new stair gate, likes to chew.

I love his smile; his spunk; his ears; his glee.

Even if sometimes I have to clean up his pee.

He's a puppy, you know - they do that stuff.

They play and they play until they've had enough.

I'm usually ready to rest well before he -

to down a juice box, or two, or twelvety three.

We run, we walk. We (sometimes) fetch, we play.

We frolick until sunset ends our day.

I knew that life with this puppy would change

And it REALLY affects the amount of time I'm in range.

Has my CGM learned yoga? Perhaps. So I thought I'd blog

The new position Jim seems to have learned: Downward Facing Dog.

I Swear, I'm Not A Ditz.

Do I lay the appropriate blame, or do I try for an Oscar?

It's a tricky line, that. When I'm sitting there at work, doing my best to hold myself together - to not let the impaired motor skills, the emerging sweat, the mind fuzz show - I really want to pretend things are totally okeh. (Not "okay" - because they're not. Just "okeh".) Sitting in that silence, I can pull it off.

But when someone comes up to me, at that worst possible moment - the charade is up. My cover; blown.

"Kim, do you know who these forms go to?"

"...um, I think...  4th floor?" (Everything comes out sounding like a question.)

"Okay... but do you know who specifically?"

"It's... um... maybe, Cassandra? I'mnotsure?"

An in-range Kim could answer that question definitively. With far less vocal fillers. But when I'm not - when I'm that kind of low that makes me want to muffle my CGM receiver in some far crevasse of my purse, and curl up under my desk for a nap - I struggle to string together words, and I just hope that they make any small amount of sense.

There are around 100 people in my building, and I don't want to have to explain to each one of them that heeeey, I've got a low blood sugar right now. Which, oh yeah, means I have diabetes. It's not always a conversation I want to have while my insides are riding some sort of rollercoaster. I just want to get that conversation over with, and move on.

But the risk of that decision is that I likely come across as an airhead.

Which, actually, would be exactly what I need right about then.

***I have not yet heard from Friday's giveaway winner, "Life as an Empty Nester". If that's you, would you please send me an email at textingmypancreas (at) gmail (dot) com with your name and phone number? If I have not heard from Friday's winner by the end of tomorrow (6/21), I'll be choosing a new winner at random from the remaining entrants!

Seeing Diabetes Everywhere.

Last weekend, Aaron and I decided to go out for some late-evening dessert and coffee.

We headed to one of our favorite places; a restaurant/bar combination. We were there late enough, and it's just far enough away from downtown that it wasn't heavily populated. Aaron and I sat at the bar; looked over the dessert list. I closed my menu and took a look at the bar in front of me.

Lots of colorful bottles; backlighting; glowing screens; sparkly glasses.

And then I noticed something.

Can't see it? I know; it's dark. Really dark. (Hey - it's a bar.)

How about now?

Let me show you in broad daylight.

My first thought? And I'm serious, here...

"Oh, someone was low."

...

Then I answered myself, "Wait, check that... probably a mixed drink." And then I felt kind of silly.

Diabetes will never leave my brain alone, will it?

That's What I Get.

For today's post, I do not aim to be eloquent or elegant.  What I do hope for is a gentle ear (or eye?) upon which I can recount this tale.

Simply put, Today seems to be what happens when I get cocky, and it's bleeping annoying.

For reasons I can't completely explain, Saturday and Sunday were great diabetes days.  I stayed around 90 most of the time, despite multiple snacks (yes, with carbs) and some SWAGing (no, I haven't kicked that habit yet).  This type of shenanigans-free blood glucose behavior is not normal for me; especially on the weekends.

Every once in a blue test trip, I'll get a day or two like this.  It gives me some confidence, and a sense of relief.  I almost start to think, Hey, you - this isn't so bad after all.  See how well you're doing?  And you're hardly trying!  You've got this!  It's all falling into place!  I want to give myself a big ol' pat on the back; like I've earned it somehow.  As if my 24 years of diabetes knowledge and experience has culminated to this focal point of awesomeness.

But, Today?, Oh no - today, that streak of awesomeness came to a skidding halt while I was at work.  Twice.

"Twice!!!"

One of the most frustrating parts is my inability to see where I went so wrong.  A little wrong?  Maybe.  But not 35 mg/dL wrong.

I ate the same breakfast.  Took the same insulin for it, 15 minutes ahead.  Then I drank my coffee - like I always do - and took a few units for it, like I always do.  I watched my number creep up to just below 130 on the Dexcom, and was still headed upwards when it was time for my daily 15-minute morning walk.  When I returned, I felt... normal.  Nothing out of place.  I got back to work, but after a few minutes felt a little weird. 

Ping and I consulted:  35 mg/dL.

"What?!?!", I shrieked, in the safe silence of my own head.  This didn't make any kind of sense.  A 15-minute walk at that time of morning is very consistent in bringing me down between 50 -60 points.  I had the same amount of IOB as I always do.  NOTHING CHANGED.

I ate some dried mango (in retrospect, not the most fast-acting choice, but that darn dietician I saw two weeks ago is still in my head:  "You need to eat more fruits!").  I waited 15 minutes, then checked again.  I was 65 and heading back up.  Whew!  Back to work.

An hour later, I'm feeling weird again.  Ping, what say you?

41 mg/dL.

"You have got to be flocking kidding me!!!", I once again yelled in my head.  Puzzled, I busted out the Starbursts.  I ate four, waited 15 minutes.  Still reading "LOW" on the Dexcom (which means under 40). 

Ate four more. 

Waited. 

"LOW". 

Ate the last four. 

Waited.

Ping told me I was at 100, and so I stayed above that for a little while - but only a little.

Lunch came and went.  My one-hour post-prandial blood test was 113.  (Sweet!)  But it came at a price - half an hour later, guess who came a-knockin'?

45 mg/dL.

I ate some more mango, the yogurt I brought but didn't eat yet, and then proceeded to also get a cookie later that afternoon.  And you want to know what that did?  I peaked at 152.  (....really?  That's it?  After all that carbtasticness?  Um, okay...)

I just really don't get it.  My basals have been unchanged for weeks, I was eating the same foods I always eat.  Bolusing the same exact way.  Nothing in my routine changed... except the outcomes.

Um, excuse me, Phil?  Could you come back out here, please?  I just need...

"Outcomes!!!"

Thanks, buddy.  I'm glad to have you on my side.

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(Sidenote:  Phil is a ClipArt image a co-worker and I use frequently.  Phil gets his name from the fact that he has "had his fill/Phil of this crap".  He always speaks in italics, and with multiple exclaimation marks.  Sometimes he says "Roight!!" with a Billy Idol-esque flair, but mostly he's just peeved about everything.  I have a feeling he'll be making more guest appearances on this blog in the future, so I thought I'd introduce you all to each other.)